Created by
Gary B. Rollman,
Emeritus Professor of Psychology,
University of Western Ontario
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Sunday, April 21, 2013

In Gaming, Some See Tools to Treat Pain - NYTimes.com

WASHINGTON — Fifteen-year-old Reilly woke up one morning with a sharp, stabbing pain in his left leg that soon spread to other parts of his body. The pain, which started early last year, forced him to quit soccer, and he spent the next four months being poked, prodded and scanned by doctors.

The test results were inconclusive. "No one could tell him why he was in a ball on the floor unable to function," said Nina, his mother, who agreed to be interviewed only on the condition that the family's surname be withheld.

Finally, last June, Dr. Sarah Rebstock, a pediatric anesthesiologist at Children's National Medical Center, gave Reilly a diagnosis of chronic regional pain syndrome. The nerve disorder is characterized by chronic and severe burning pain, pathological changes in bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch.

The sight of the teenager reaching in the air and shuffling from side to side as his on-screen avatar hurled down an intergalactic tube racking up rings and gems seemed unremarkable. After all, game consoles like Microsoft's Xbox and Nintendo's Wii have become ubiquitous in American households, and many hospitals and clinics use them to add an element of fun to physical therapy.

But TubeRunner is one of four of galaxy-themed video games created specifically for this complex, where pain specialists and game developers are piloting an approach to measuring pain. Dr. Julia Finkel hopes that using technical data from games and interactive activities to objectively identify and monitor pain can help determine how to evaluate the techniques used to treat it.

Central to their effort to quantify pain, said Dr. Finkel, the chief of pain medicine here, is a squat, rectangular black box with three eyes peering up from below the screen. It was a Kinect, a motion sensor device that allows users to control games using gestures and spoken commands.

More important for Dr. Finkel was the device's tracking of 24 points on Reilly's body in three dimensions, feeding data about his movements — angles, distance, speed, frequency — to a secure database. Custom software measures his heart rate and converts all of the data to graphics that a physical therapist can see on a tablet computer in real time.

"Since it's digital information, we can manipulate it, understand it, analyze it," Dr. Finkel said. "So from a research perspective, it's a treasure trove of information that would help us formulate new metrics in order to treat these patients."

Danica Zimmerman, 14, saw more than 20 doctors for the burning pain that started last year in her right hand and quickly spread to her other limbs. Many of the doctors told her that the pain, which forced her to quit swimming and refuse hugs, was all in her head. She finally received a diagnosis of reflex sympathetic disorder, another name for chronic regional pain syndrome.

As Danica walked around the complex recently, wearing smiley-faced pajama pants and attached to an IV containing ketamine, she stopped to play a game of Meteor Bounce.

Dr. Rebstock, the director of the complex, said it was normal for her teenage patients to see a handful of doctors before getting the right diagnosis. The National Academies estimates that about 100 million adults in the United States suffer from chronic pain; hospital officials say that between a quarter and a half of children under 18 experience chronic pain lasting more than three months.

"Physicians don't often recognize pain as a pathology," Dr. Rebstock said. "And so patients end up seeing a lot of doctors trying to figure out what's wrong."

The measures developed using the Kinect data could help reduce errors and could easily apply to pain treatment for adults, and even for other chronic conditions like autism, cancer and diabetes, Dr. Rebstock said.

Microsoft released the Kinect for Windows last year as the company was encouraging researchers to explore health applications for the device, which was originally created for the Xbox game console.

Using technical data to assess and treat pain could allow clinicians to replace current methods that Dr. Finkel said were trial and error. Current therapy relies on the patients and doctors to gauge pain by feelings and observations.

The games draw on techniques from physical therapy and yoga to distract children from their pain, but also to increase their range of motion and strength. Clinicians will be able to use initial measurements to determine a baseline range of motions that each patient can perform in pain. By looking at how patients' movements change over time, doctors will be able to determine whether a therapy works.

Dr. Hamid Ekbia, a research professor at Indiana University Bloomington, is developing a game system for stroke patients that would automatically document, maintain and analyze data on the patient's condition and treatment. The option of in-home treatment would provide increased access to care and a way around insurance restrictions that cap therapy sessions at about 15 to 20 visits, limits that leave patients on their own after a few weeks, he said.

"If we can capture this data that shows the progress of the patient, and allow the therapist to document how the patient is doing and even generate automatic reports, that's going to provide a lot of savings of money and time," Dr. Ekbia said.

For the technology to really progress, he said, insurers and lawmakers must change policies to cover the cost of the consoles and to reimburse clinicians for time spent looking over patients' data.

"Our fear is that we will develop all of this and finally we'll hit this policy barrier or this reimbursement barrier," Dr. Ekbia said. "And people might not be able to pick this up just because of those barriers."

The clinicians at Children's National Medical Center are working with developers from Interface Media Group to modify the game system for patients to buy and use at home. Relying on motion tracking and Internet cloud services, physical therapy administered through game consoles would allow clinicians to develop personalized exercise routines based on a patient's condition.

"It's just like your iPhone," Dr. Rebstock said. "Generation one wasn't nearly as cool as whatever we have now. So this is generation one."